July 2006, Volume 33, Number 4
Oncology Nursing Society Position
Breast Cancer Screening
Breast cancer is a significant public health problem. Although all women are at risk for developing breast cancer, the risk is greater in women as they grow older, especially after the age of 40, and in women with a hereditary predisposition for developing breast cancer. Breast cancer treatment is usually less aggressive and better tolerated when the disease is detected early. Currently, the three primary tools used for the early detection of breast cancer are breast self-examination (BSE), clinical breast examination (CBE) by a healthcare provider, and mammography (National Comprehensive Cancer Network [NCCN], 2005).
Systematic monthly BSE has been recommended since 1933; however, more than 30 nonrandomized trials have produced conflicting results about the efficacy, sensitivity, and specificity of the practice (Austoker, 2003; Havey, Miller, Baines, & Corey, 1997). The effectiveness of BSE is largely dependent on the skill of the woman practicing BSE, and the consensus is that BSE should be used in combination with other breast cancer screening modalities (NCCN, 2005).
Sensitivity for CBE has been reported to range from 40%69%, and its specificity ranges from 88%99% (Humphrey, Helfand, Chan, & Woolf, 2002). Trials in which CBE is combined with mammography have demonstrated a mortality reduction of 14%29% (Humphrey et al.). Like BSE, the sensitivity and usefulness of CBE is related, in part, to the skill of the healthcare provider performing the examination. When CBE is performed prior to mammography, it may be useful in identifying an area of suspicion that might not be readily visible on mammography or provide guidance in selecting additional imaging techniques (Smith, 2003).
The primary evidence for supporting mammography comes from seven large randomized clinical trials that show a statistically significant mortality reduction from breast cancer in women aged 4069 years who underwent regular mammography screening (Smith et al., 2003). Overall, the trials suggested a 24% mortality reduction associated with mammography use. The sensitivity for annual mammography ranges from 71%96%, with lower sensitivity seen in younger women who tend to have dense breasts, and specificity ranges from 94%97% (Humphrey et al., 2002).
It Is the Position of ONS That
Austoker, J. (2003). Breast self-examination: Does not prevent deaths due to breast cancer, but breast awareness is still important. BMJ, 326, 12.
Havey, B.J., Miller, A., Baines, C., & Corey, P.N. (1997). Effect of breast self-examination techniques on the risk of death from breast cancer. Canadian Medical Association Journal, 157, 12051212.
Humphrey, L.L., Helfand, M., Chan, B., & Woolf, S.H. (2002). Breast cancer screening: A summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 137(5, Pt. 1), E347E367.
National Comprehensive Cancer Network. (2005). Breast cancer screening and diagnosis guidelines version 1.2005. Retrieved February 2, 2006,From
Smith, R.A. (2003). An overview of mammography: Benefits and limitations. Journal of the National Comprehensive Cancer Network, 1, 264271.
Smith, R.A., Saslow, D., Sawyer, K.A., Burke, W., Costanza, M.E., Evans, W.P., et al. (2003). American Cancer Society guidelines for breast cancer screening: Update 2003. CA: A Cancer Journal for Clinicians, 53, 141169.
Approved by the ONS Board of Directors 3/06.
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